The battle against nasopharyngeal cancer

Abstract

Nasopharyngeal cancer (NPC) is one of most difficult cancers to treat because of its highly malignant natural behavior and its anatomical proximity to critical structures. This cancer was invariably lethal before the advent of megavoltage radiotherapy (RT). Dr John Ho from Hong Kong was the leading pioneer in the battle against NPC. His foresight in identification of environmental carcinogens, the need for accurate prognostication by customized staging system, and the design of radiotherapy technique set the foundation for our understanding of this peculiar disease. Over the past 30 years, clinical oncologists from Hong Kong have made concerted efforts to continue this pursue. The statistics from the Hong Kong Cancer Registry from 1980 to 2009 showed that the age standardized incidence rate of NPC has decreased by 51% for male and 59% for female populations. Together with improving treatment results, the corresponding agestandardized mortality rate has decreased by 60% and 67%, respectively. With advances of the technology of both diagnostic imaging and RT, together with development of concurrent cisplatinbased chemotherapy for locoregionally advanced NPC, retrospective analyses of 1374 consecutive patients treated at our institute (Pamela Youde Nethersole Eastern Hospital) from 1994 to 2007 showed significant improvement in cancerspecific survival from 79% in the era of 2dimensional conventional RT, 81% in the era of 3dimensional conformal RT, to 88% in the recent era of intensitymodulated RT. We have indeed achieved gratifying progress in this difficult battle against NPC, but there is no ground for complacency. Many serious problems remain to be solved: this cancer remains one of the most prevalent cancers in South East Asia, majority of patients still present with advanced disease, distant failure remains a key failure despite chemotherapy, late toxicities still seriously affects survivors’ quality of life. Furthermore, more accurate prognostic and predictive factors are needed for working towards the ideal goal of personalized medicine. Concerted efforts by all are needed to realize the dream of controlling this nasty cancer within our life time.